Soft Tissue Massage

Question 1

What are benefits of soft tissue massage?

Answer 1

Promotes local and systemic relaxation
Increases local blood flow
Breaks down adhesions
Facilitates venous return

Question 2

What are specific situations STM is used in an AT setting?

Answer 2

Edema removal
Chronic back/neck injuries
Tendonitis and ITB friction syndrome
Chronic muscular injuries-scar tissue

Question 3

What are indications of STM?

Answer 3

Pain                          Anxiety
Edema                      Decreased ROM
Muscle spasm
Trigger points
Adhesions/Scar tissue

Question 4

What are contraindications of STM?

Answer 4

Acute inflammation
Infection-systemic/skin
Skin Conditions
DVT
Tissue Irritability
Malignancies

Question 5

What is Effleurage?

Answer 5

most versatile and frequently used
“Stroking”-smooth, firm, continuous motion, adapt speed
Enhances venous flow, deep effleurage provides some stretch to muscle

Question 6

Effluerage: Soft tissue

Answer 6

fingerpads

stimulates sensory nerves

Question 7

Effluerage: Deep tissue

Answer 7

use palms or knuckles

stimulates deep tissues

Question 8

Basic Effleurage

Answer 8

Palms of the hands conform to tissue (parallel to body part)
Start off very light gliding over skin and begin gentle increase of pressure
Can use palms, fingers, thumbs, fists, forearms

Question 9

Shingles Effleurage

Answer 9

Continuous alternating (b/w hands) stroking
Strokes overlay each other
One hand always remains in contact
Done many times parallel to the spine

Question 10

Petrissage

Answer 10

Lifting, kneading, wringing, rolling tissues
Targets muscle
Progress depth of treatment-alter speed
basic 2-handed kneading: lift, squeeze, release ST

Question 11

Purpose of Petrissage?

Answer 11

Separates muscle fiber, fascia, and scar tissue

Milks the muscle of waste products, assists with venous return and relaxes muscle.

Question 12

Skin rolling: Petrissage

Answer 12

Tissue picked up b/w thumb and first two fingers, gently pull away from deeper tissues
Thumbs can push forward causing a rolling effect

Question 13

Tapotement

Answer 13

Percussion
Stimulates muscular and systemic relaxation
Desensitization of irritated nerve endings

Question 14

Types of Tapotement

Answer 14

gentle tapping or pounding
Most common: “hacking (karate chop)”
Pincement
Cupping

Question 15

Hacking

Answer 15

hands face each other
hands and wrist held loosely
rapid percussion mvmt

Question 16

Rapping

Answer 16

similar to hacking but using lightly closed and loosely held fists

Question 17

Cupping

Answer 17

Rapidly alternating force
Cup hand so thumb and fingers are slightly flexed and palmer surface contracted
Contract surface of skin with outside surface of cupped hand

Question 18

Pincement

Answer 18

Rapid gentle mvmt of picking up skin b/w thumb and first two fingers
aka: “plucking”

Question 19

Deep Transverse Friction

Answer 19

Friction, cross-friction, DTF, deep massage, deep transverse/friction massage
Developed by James Cyriax

Question 20

What is DTF indicated for?

Answer 20

muscle, ligament, and tendon injury

Question 21

Proposed mechanism of action for DTF

Answer 21

pain relief via gate control/endogenous opiate release
Collagen re-orientation during maturation phase
prevention of adhesions
ruptures existing adhesions-increased ROM
Increases local blood perfusion

Question 22

Friction

Answer 22

breaks up adhesions by way of increasing space b/w collagen fibers
Fingers and skin move together
directly over lesion

Question 23

What are the two types of friction?

Answer 23

Transverse

Friction

Question 24

Transverse friction massage

Answer 24

strokes perpendicular to tissue fibers

thumbs or fingertips stroke in opposite direction

Question 25

Circular friction massage

Answer 25

Used to:
break up scar tissue
soften a healing scar

Question 26

Tx protocol for DTF

Answer 26

Cyriax: 6-12 sessions, alternate days
Starkey: once per day
Mvmt should be perpendicular to fibers

Question 27

Edema Reduction Massage Preparation

Answer 27

elevate body area
apply massage lubricant to skin
clinician is positioned distal to extremity

Question 28

What is the stroke sequence

Answer 28

begin proximal to the edematous area
long, slow deep strokes towards torso
move starting point slightly distal every 4th or 5th stroke
when it starts to be more distal to edema, begin working back towards starting point

Question 29

Termination

Answer 29

Remove medium
if appropriate: AROM exercises
Compression wrap
Encourage pt to drink water to assist in flushing metabolic waste